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Barriers to and facilitators of clinical practice guideline use in nursing homes.

Publication ,  Journal Article
Colón-Emeric, CS; Lekan, D; Utley-Smith, Q; Ammarell, N; Bailey, D; Corazzini, K; Piven, ML; Anderson, RA
Published in: J Am Geriatr Soc
September 2007

OBJECTIVES: To identify barriers to and facilitators of the diffusion of clinical practice guidelines (CPGs) and clinical protocols in nursing homes (NHs). DESIGN: Qualitative analysis. SETTING: Four randomly selected community nursing homes. PARTICIPANTS: NH staff, including physicians, nurse practitioners, administrative staff, nurses, and certified nursing assistants (CNAs). MEASUREMENTS: Interviews (n=35) probed the use of CPGs and clinical protocols. Qualitative analysis using Rogers' Diffusion of Innovation stages-of-change model was conducted to produce a conceptual and thematic description. RESULTS: None of the NHs systematically adopted CPGs, and only three of 35 providers were familiar with CPGs. Confusion with other documents and regulations was common. The most frequently cited barriers were provider concerns that CPGs were "checklists" to replace clinical judgment, perceived conflict with resident and family goals, limited facility resources, lack of communication between providers and across shifts, facility policies that overwhelm or conflict with CPGs, and Health Insurance Portability and Accountability Act regulations interpreted to limit CNA access to clinical information. Facilitators included incorporating CPG recommendations into training materials, standing orders, customizable data collection forms, and regulatory reporting activities. CONCLUSION: Clinicians and researchers wishing to increase CPG use in NHs should consider these barriers and facilitators in their quality improvement and intervention development processes.

Duke Scholars

Published In

J Am Geriatr Soc

DOI

ISSN

0002-8614

Publication Date

September 2007

Volume

55

Issue

9

Start / End Page

1404 / 1409

Location

United States

Related Subject Headings

  • Quality Indicators, Health Care
  • Quality Assurance, Health Care
  • Qualitative Research
  • Professional Competence
  • Practice Guidelines as Topic
  • Nursing Homes
  • North Carolina
  • Humans
  • Health Personnel
  • Guideline Adherence
 

Citation

APA
Chicago
ICMJE
MLA
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Colón-Emeric, C. S., Lekan, D., Utley-Smith, Q., Ammarell, N., Bailey, D., Corazzini, K., … Anderson, R. A. (2007). Barriers to and facilitators of clinical practice guideline use in nursing homes. J Am Geriatr Soc, 55(9), 1404–1409. https://doi.org/10.1111/j.1532-5415.2007.01297.x
Colón-Emeric, Cathleen S., Deborah Lekan, Queen Utley-Smith, Natalie Ammarell, Donald Bailey, Kirsten Corazzini, Mary L. Piven, and Ruth A. Anderson. “Barriers to and facilitators of clinical practice guideline use in nursing homes.J Am Geriatr Soc 55, no. 9 (September 2007): 1404–9. https://doi.org/10.1111/j.1532-5415.2007.01297.x.
Colón-Emeric CS, Lekan D, Utley-Smith Q, Ammarell N, Bailey D, Corazzini K, et al. Barriers to and facilitators of clinical practice guideline use in nursing homes. J Am Geriatr Soc. 2007 Sep;55(9):1404–9.
Colón-Emeric, Cathleen S., et al. “Barriers to and facilitators of clinical practice guideline use in nursing homes.J Am Geriatr Soc, vol. 55, no. 9, Sept. 2007, pp. 1404–09. Pubmed, doi:10.1111/j.1532-5415.2007.01297.x.
Colón-Emeric CS, Lekan D, Utley-Smith Q, Ammarell N, Bailey D, Corazzini K, Piven ML, Anderson RA. Barriers to and facilitators of clinical practice guideline use in nursing homes. J Am Geriatr Soc. 2007 Sep;55(9):1404–1409.
Journal cover image

Published In

J Am Geriatr Soc

DOI

ISSN

0002-8614

Publication Date

September 2007

Volume

55

Issue

9

Start / End Page

1404 / 1409

Location

United States

Related Subject Headings

  • Quality Indicators, Health Care
  • Quality Assurance, Health Care
  • Qualitative Research
  • Professional Competence
  • Practice Guidelines as Topic
  • Nursing Homes
  • North Carolina
  • Humans
  • Health Personnel
  • Guideline Adherence